Mistake of ignoring monkeypox outbreak in Nigeria

There are no clear answers to how humans are infected as the host animal has not been identified

Monkeypox was first reported in 1958 in laboratory monkeys and the first human case was reported in 1970 in a nine-month-old baby in the Democratic Republic of Congo. Nigeria reported its first case of monkeypox in humans in 1970 when one case was detected; there were two human cases of monkeypox in Nigeria in 1978. And after nearly four decades of not reporting any cases, monkeypox (West African clade) made a re-emergence in Nigeria in September 2017. From September 2017 to April 30, 2022, Nigeria has reported 558 cases, of which 231 have been laboratory confirmed. There have been dozens of confirmed cases each year in Nigeria since 2017 — 88 in 2017, 49 in 2018, 47 in 2019, eight in 2020, and 34 in 2021. There have been 15 confirmed cases between January 1 and April 30, 2022.

Based on epidemiological and clinical characteristics of 122 confirmed or probable cases of human monkeypox cases in Nigeria between September 22, 2017 and September 16, 2018, researchers found both primary zoonotic and human-to-human transmission. Two cases of healthcare-associated infection were recorded. Based on genome sequencing, the researchers found multiple introductions of the virus, and a single introduction along with human-to-human transmission in a prison facility. The results were published in the journal  The Lancet Infectious Diseases.

Since the outbreak began in Nigeria in 2017 and prior to the latest outbreak in Europe and North America, there have been at least eight instances when monkeypox has been exported to countries outside Africa — the U.K., the U.S., Israel and Singapore. Like all diseases that are endemic only to Africa, the story repeats again. While efforts were made to prevent an outbreak in the non-endemic countries outside Africa, no serious international attempts were made to stop the outbreak in Nigeria nor study the virus characteristics.

According to  Stat News, Dr. Chikwe Ihekweazu, the former director general of the Nigeria Centre for Disease Control had sought help to try to decipher what was going on with monkeypox but without success. While in 2003, the U.S. reported the first human case of monkeypox, the virus had only crossed the species barrier from rodents imported from Ghana to one person. Human-to-human transmission outside Africa was first reported in September 2018, when the monkeypox virus spread from a patient to a healthcare worker in the U.K.

The current outbreak in Europe and North America is the first instance when large-scale human-to-human transmission has been reported outside Africa. The index case was a U.K. resident, who travelled to Nigeria on April 20 and returned on May 3; he was diagnosed with monkeypox on May 6, 2022. It has since spread to 219 people as of May 25 across 20 countries.

The wealthy nations are now waking up to the reality of monkeypox crossing international borders and causing outbreaks in countries where it is not endemic.

“Attention is only paid when certain diseases hit high-income countries — exemplifying our collective failure to properly address ‘epidemic preparedness’ and ‘global health’. It also illustrates the double standard applied to how people’s health is valued between wealthy countries and the rest of the world,” Dr. Emmanuel Nakoune from Institut Pasteur Bangui, Central African Republic and Dr. Piero Olliaro from the Pandemic Sciences Institute, University of Oxford write in the  BMJ.